Acute kidney injury after TAVI: Predict, detect, and prevent

Abstract

Acute kidney injury (AKI) is frequently observed immediately after transcatheter aortic valve implantation (TAVI). Both classifications, the RIFLE (the Risk, Injury, Failure, Loss, and End-stage Kidney) and the KDIGO (Kidney Disease: Improving Global Outcomes) from the VARC-2 (Valve Academic Research Consortium-2) are fairly interchangeable and performed well as clinical predictors of all-cause mortality. Patients with baseline reduced glomerular filtration rate (GFR) or known atherosclerotic arterial disease are at increased risk of AKI.

Impact of Post-Procedural Acute Kidney Injury in Patients Undergoing Surgical Aortic Valve Replacement Versus Transcatheter Aortic Valve Implantation

“…Among these, post-procedural AKI is a frequent complication of both surgical and transcatheter procedures. In our analysis, the incidence of AKI was 28.9% among SAVR patients and 5.9% among TAVI patients in accordance with literature findings, even if post-procedural AKI in TAVI patients tends to be slightly higher [2][3][4].…”

“…Its incidence varies between 4% and 49% depending on AKI definition and study population characteristics [2,3]. AKI has been shown to be associated with increased short-and long-term morbidity and mortality after cardiothoracic surgery [4,5]. The pathophysiological mechanisms underlying the onset of AKI in SAVR versus TAVI patients are different.…”

Advances in cardiac CT contrast injection and acquisition protocols

“…Nevertheless, persistent renal dysfunction after coronary CTA due to iodine CM is rare (49). In comparison, risk of CIN in multimorbid patients referred for TAVR planning is increased with higher amount of acute kidney injury after the procedure (50). Intravenous prehydration as a prophylaxis has shown no benefit compared to no prophylaxis in the prevention of CIN in high-risk patients (eGFR 30-60 mL/min/1.73m²).…”